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Parkinsons disease affects the nervous system. It muddles how the brain sends signals that coordinate movement. In Vermont, it's estimated that one out of a thousand people over age 55 have it.

It's a lifelong condition, and there's no cure. But research shows vigorous exercise and even a punch or two can help those with Parkinson's slow the disease.

At the Carter Community Building Association, a nonprofit recreational center in Lebanon, New Hampshire, Ann Harvey, Tom O'Quinn and Suzanne Serat are slipping on brightly-colored padded gloves.

They use them in a special boxing class designed to help people fight Parkinsons.

Nina Keck

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Vermont Public

"Theres this thing in Parkinson's that says if you have a positive attitude, youll be better, and thats true," Serat says. "But, you also need to acknowledge that its really hard, and youre sort of losing your life basically drop by drop, and youre mad about it."

"And," she gestures to the bright blue boxing gloves on her hand, "it feels good to just hit that bag as hard as you can.

The group heads into a small gymnasium where punching bags hang from the ceiling.

Alright guys, were going to get started," calls out instructor Samantha Duford. "So boxing stance, hands up. Were going to throw a jab jab, hook hook, upper upperOkay? Lets go

The dangling bags suddenly come to life, rocked by jabs from either side.

Nina Keck

/

Vermont Public

Betsy Warren of West Lebanon smiles behind her mask as she gives her bag a one-two combo.

Warren was diagnosed with Parkinson's in April 2021. Eight months later, she was diagnosed with cancer. She wrapped up chemo this summer, and is in remission. So now, she says, shes back to focusing on her Parkinsons.

This class, called Rock Steady Boxing, is based on a nationally-recognized curriculum, and Warren says its helping.

Oh, its the greatest workout," Warren gushes, breathing hard during a break. "Theres like 23 different things that we do, and its all good for Parkinson's, from yelling, using our voice, to big movements."

She adds: "The thought of hitting something seemed like a good idea, especially early on when youre trying to get used to a diagnosis.

Nina Keck

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Vermont Public

Parkinsons disease affects how people move. It slows them down and can make people stoop and shuffle. Tremors are common. The disorder can also weaken a persons voice, affect eyesight and balance, and can hamper fine motor skills, which can make everyday tasks like buttoning a shirt difficult.

More from Brave Little State: How can older Vermonters 'age in place'?

Physical therapist Samantha Duford is president and cofounder of Upper Valley Programs for Parkinson's. She says her 90-minute Rock Steady Boxing classes target all of those things.

Nina Keck

/

Vermont Public

We incorporate balance, coordination and dual-task walking," Duford says. "We really try totarget deficits specific to Parkinson's in everything we do.

Boxing she says is great for big arm movements and getting heart rates up. But the class also includes yoga stretches, core strength training, brain teasers and hand-eye work. For instance, one of this afternoon's activities involves moving lettered clothes pins from one ribbon to another in alphabetical order while balancing on a cushion.

Suzanne Serat and others in the class say the benefits are immediate.

"Absolutely, when I came into class, I was having something called dyskinesia, which is a random movement and side effect from the medication," Serat says. "And because of doing this, it stopped. So this leg is now still.

Nina Keck

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Vermont Public

That's not uncommon. Dr. Jim Boyd is director of the Binter Center for Parkinson's Disease and Movement Disorders at the University of Vermont. He says that while intense activity wont stop symptoms, it can slow them down and make them go away temporarily. Its why he says classes like this are so important.

"As a practicing neurologist for nearly 20 years now, you do see a distinct difference between those who become engaged in physical activity early in their course, and develop good habits of exercise, to those that do not," he says.

If boxings not your thing, Boyd says there are dance classes, Tai chi and other workouts specifically designed for people with movement disorders that can help. And since COVID, many are now offered virtually.

Gary Martin lives in Jonesville, Vermont, and was diagnosed with a movement disorder similar to Parkinsons 10 years ago. Martin takes a regular dance class for people with Parkinsons taught by his wife Sara McMahon. He also does a specialized workout called Push Back several times a week.

While hes now using a walker and wheelchair more often, he says the weekly classes have helped his balance, strength and outlook.

"The tendency for most people with Parkinson's [is] to just hang back and not become involved in life," Martin says. "And this has really been helpful in that regard.

Nina Keck

/

Vermont Public

Back at the Rock Steady Boxing class, the group wraps up its weekly workout in a circle.

Earnest Schori says he was diagnosed with Parkinson's in 2018, and besides boxing, he does Tai chi and core strength training. The physical outlet helps, he says, but so does the camaraderie.

"To know that I'm not alone," Schori says, is important.

Suzanne Serat nods. The workouts feel great, but she says the teasing and support that are part of every class the catching up with each other, the understanding and honesty may be even more important.

"You dont have to explain anything. There's none of you that needs to be embarrassed," Serat says."I dont know why, but theres a shame that comes from having a chronic illness, one that shows, and theres none of that when were all together."

Pointing to the clusters of others in the group who are chatting and laughing after class, she says: "You can just sort of sit there and say, 'Its not a good day,' and theyll go 'Yeah.' They get it.

Have questions, comments or tips?Send us a messageor get in touch with reporter Nina Keck:

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In the Upper Valley, fighting back against Parkinson's with a one-two punch - Maine Public

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The history of medical education has attracted substantial interest over the past few years, and medical education has moved toward outcome-based education (OBE) [1-10]. This paradigm has been necessitated by increasing concerns about accountability, cost-effectiveness, and rising expectations of the community regarding what future physicians can do to meet their needs[1,3,5,11-14]. Enthusiasm for competency-based medical education (CBME) has translated into the establishment of competency-based frameworks for medical graduates in many countries, for example, the Can Meds (Competency framework approved by the Royal College of Physicians and Surgeons of Canada); Tomorrows Doctor; the Scottish Doctor; and the Accreditation Council for Graduate Medical Education (ACGME)[4,8,15-17]. Moreover, many medical schools are adopting these frameworks in their curricula[6,18]. In contrast to the traditional time-based model, CBME de-emphasizes time and concentrates on how the student can actually perform at the end of their course of study[2,4,10,11,18]. Despite the wide reputation and implementation of this educational strategy, some challenges remain to be addressed, which include the definition of competencies and the development of authentic methods of assessment of these competencies[5]. In addition, the lack of shared discourse and terminology is another reported limitation that currently compromises the full promise of CBME[4,12,13,17,19].

Saudi Arabia was not uncompetitive and has made recognizable efforts recently to establish national competency frameworks for medical graduates[10,16,20-22]. Such national frameworks aimto provide a common platform on which the curricula of medical schools in the kingdom can be grounded and against which all Saudi medical graduates can be compared in terms of skills and knowledge[10,21,23]. This approach has been deemed necessary, particularly in view of the unprecedented expansion in the establishment of medical colleges in the kingdom within the past decade[15,21,23]. In addition, the development of such national frameworks would bring medical education in line with the values, traditions, and cultural background relevant to Saudi Arabia[6,15,16,24]. These efforts have been supported by the birth of the National Commission for Academic Accreditation and Assessment (NCAAA) and the Saudi Medical Education Directives (SaudiMEDs) competency frameworks[22]. The NCAAA, founded in 2004 and responsible for the accreditation and quality assurance of postsecondary training programs, drafted the Learning Outcomes for bachelor's degree programs in Medicine in 2010, which comprises five knowledge and skill domains[10,16,22]. Later, and with regard to medical education, an initiative led by a committee of deans of medical colleges in Saudi Arabia, produced an initial draft of the SaudiMEDs in 2010, which was later updated in 2015. The NCAAA and the SaudiMEDs frameworks were cross-referenced to ensure congruence and consistency between the two national frameworks. All medical schools in Saudi Arabia are now required, as part of their accreditation process, to demonstrate that their curricula include the competenciesand domains of knowledge and skills that are in accordance with these national frameworks[22].

Harden defines curriculum mapping as the process of indexing elements and linking them, as well as incorporating other phenomena such as people and timetable [7]. A curriculum map can be assembled by examining a curriculum through different perspectives, including learning outcomes, subject areas, teaching and learning opportunities, and assessment strategies[25,26]. It has been asserted that the functional linkages between the different objects in a map provide more information than would otherwise be the case with a linear representation of these objects[19,25]. Such a graphical representation of the contents of a curriculum depicts what is taught and elucidates how and where topics are covered, thus making the curriculum more transparent and easily accessible to all concerned parties in the learning process[19]. Curriculum mapping is therefore considered to be a powerful tool for curriculum development because it can highlight gaps as well as redundancies in the formal curriculum[5,9,12,19,27,28]. Lately, several medical training programs and institutions in Saudi Arabia have attempted to map their curricula to certain international and national competency frameworks in response to the growing concerns over improving the quality of their programs and graduates and to meet the requirements of accreditation and quality assurance processes[2,6,14,26].

To establish the background for this study, this section provides more details regarding the national competency frameworkfor medical graduates in Saudi Arabia: the SaudiMEDs. The project was launched in 2009 and was planned to be carried out in three phases. The first and second phases have been concluded, while the third phase is still ongoing[16,22]. Phase 3 aims to provide detailed specifications of the competencies expected at the end of the internship year, which, in this initiative, is considered to be an integral part of the basic medical curriculum. The SaudiMEDs comprises six main domains, 17 essential competencies, and 80 learning outcomes that should be fulfilled by all undergraduate medical programs in the kingdom[21,22]. The framework also consists of 178 clinical presentations, classified according to body systems, and 123 essential skillsrelated to six categories, which all medical graduates should learn by the time of their graduation[29]. The SaudiMEDs framework aims to specify the core abilities of the future Saudi doctor and serves as a mechanism to ensure the comparability and equivalence of the outcomes of undergraduate medical education all over the country. The framework is meant to inform undergraduate medical curricula in Saudi Arabia and not to replace them, thereby preserving medical schools autonomy in the delivery of high-quality medical education that is still based on the schools particular contexts and individual needs[16,21,22].

The Faculty of Medicine at the University of Tabuk implements an outcome-based, community-oriented curriculum designed as a modular system and has three phases that are delivered over six years. The internship period, the seventh year, is not yet a part of our undergraduate curriculum. Initially, the curriculum was adopted from the medical college at King Abdul-Aziz University as a mother college, and it embraces a multilayered, longitudinally, horizontally integrated, and interdisciplinary approach [4,17]. Each module is organized based on a set of learning outcomes and appropriate teaching, learning, and assessment strategies to help students achieve those outcomes. Phase 1 is the preparatory year, which involves general science subjects and the scientific English language. Phase 2 represents the second and third years and comprises system-based, integrated moduleswhich deliver basic sciences and applied clinical knowledge. In the third and final phase, students receive comprehensive discipline-based clinical studies and rotations. Successful performance in each phase is mandatory for the student to advance to the next phase.

Curriculum development in our college was a major concern for successive administration leaders[16,23,27]. In 2011, in collaboration with the University of Queensland in Australia, an initial evaluation of the curriculum was conducted with regard to its comparability with the Liaison Committee on Medical Education (LCME) and the United States Medical Licensing Examination (USMLE) standards. Recently, with the release of the NCAAA and SaudiMEDs competency specification reports, it became mandatory for all Saudi medical colleges to demonstrate the alignment of their curricula with these national frameworks as part of accreditation and recognition of their programs in the kingdom[9,16,21].

This study aims to assess the degree of congruence between our curriculum and the SaudiMEDs, and hence the NCAAA systembecause the two were cross-referenced successfully, as mentioned in the foregoing[9,16,17,27,28]. We aim to map our curriculum to determine the extent to which it is aligned with the SaudiMEDs and to identify any gaps in respect of accreditation of our program and its future development[9,12,19,27].

We believe that this exercise has fundamental advantages and implications for our college. In addition to fulfilling the requirements of the accreditation process [6,19,27], which has already been launched, it may delineate areas of deficiency and redundancy in our curriculum and enable curriculum planners to tailor these in a more efficient manner[6,19,22,26-28]. This is particularly vital in view of the tight schedules that characterize modular systems such as the one our college employs[28]. Moreover, the curriculum map may improve transparency and access for all stakeholders, for example, students, teachers, module coordinators, and program leaders, to the curriculum and help them better plan their learning, teaching, and development actions, with all working toward a common goal[5-9,11,15,20,26,27]. This study may provide evidence of curriculum evaluation and development approaches in our college, which are essential for internal quality assurance processes, and reassure different stakeholders regarding the feasibility and outcomes of our program[2,6,14,26]. Finally, yet importantly, it may encourage other medical schools to perform the same exercise, which could eventually provide crucial feedback to the steering committee of the SaudiMEDs initiative.

This study was approved and funded by the Deanship of Scientific Research at the University of Tabuk (UT-127-21-2020). This is a descriptive-analytical study that aims to map the curriculum of the Medical College of the University of Tabuk against the SaudiMEDs specification framework. We developed a checklist to collect data from all modules based on the list of clinical presentations and skills that are deemed essential to be covered and mastered by students upon graduation as outlined in the SaudiMEDs framework[29]. The checklist consisted of the 178 clinical presentations and the 123 essential skills listed in the SaudiMEDs specification document. The checklist specifies where each clinical presentation or skill is taught in our modules, how much time is spent on that task [6,19], and how is it assessed, postulating that the coverage of these clinical topics and skills would indicate that our curriculum is congruent with the SaudiMEDs framework because competency is considered to be an aggregation of knowledge and ability[5,6,8,15,18,19,26]. The aim was to develop a content or expertise map that breaks down the subjects taught in our modules and reallocates them to form clusters of expertise around the main subject areas contained in the SaudiMEDs[6,14,19,26-28]. We invited four module coordinators randomly to the pilot phase and asked them to complete the checklist and make comments regarding the process and the number of instructions provided. A message was disseminated to the faculty regarding the project aims and its advantages to our college in a formal meeting led by the dean, and the timeframe for the completion of the project was also discussed. Then, each module coordinator, with the help of other instructors who teach the course, was asked to fill out the checklist based on the modules study guideunder supervision and with the assistance of the researchers[8,20].

Following the completion of the checklist by all module coordinators, the researchers revised all the data and checked for deficiencies and/or inconsistencies, and wherever necessary, module coordinators were contacted again to clarify and verify their entries. Researchers also checked to ensure that the entries in the checklist were based on what is documented in the study guide of the relevant module so as to reflect the situation in reality[14,26]. In the final stage, we gathered the information from all the checklists and combined it all into a final, single checklist of the same kind. Data analysis was first done manually. In the final checklist we calculated the percentages of the essential clinical presentations and skills not covered in the program. Then we used the Excel software (Microsoft Inc, USA, 2010) to draw graphical representations of where those topics and skills are addressed in our taught modules and academic years. The aim was to draw a content map of the curriculum oriented around the main knowledge and skill domains of the SaudiMEDs competency framework. Also, we mapped the clinical presentations and essential skills contained in the SaudiMEDs against the taught modules in our program using Excel (Microsoft Inc, USA, 2010) to provide further evidence of how and where the formers are addressed in our curriculum.

Twenty-seven module coordinators completed the checklist for each module reporting in total the 34 modules taught in the College. The clinical presentationmap shows the contribution of each academic year to the main subject areas of the SaudiMEDs (Figure 1). The coverage of these clinical presentations in our curriculum is approximately 96.1%. Figure 2 shows the skills map, which highlights the contribution of each academic year to the achievement of the main skill domains as indicated in the SaudiMEDs framework. It was found that our curriculum-excluding the preparatory and internship years-currently contains around 76.1% of the skills deemed to be necessary by the SaudiMEDs. The color mix in each column of the academic years reflects horizontal integration, whereas the continuity of each color through all academic years represents vertical integration. Plotting the taught modules against the main skill and knowledge domains of the SaudiMEDs specification matrix in Excel (Microsoft Inc, USA, 2010) produced a characteristic shape of barcode, which identifies our program in comparison to the national competency framework, as shown in Figure 3. Also, we drew visual maps which show the taught modules clustered around the main knowledge and skill domains of the SaudiMEDs framework to demonstrate the contribution of the formers to the achievement of the latter(Figures 4, 5), respectively.

Curriculum mapping is a process wherein the curriculum is analyzed based on its basic units, and links are made to show how these units are related to each other[6]. This study aims to create a map in which the contents of our curriculum that is taught are clustered around the main subject and skill domains of the SaudiMEDs competency framework.

The clinical presentations and skills mapproduced by our study provide a picture of where all of these areas of knowledge and skills are taught and yield a graphical orientation of the different academic years of our program through plotting the SaudiMEDs domains. This visual representation of the relationship between the modules in each academic year and their contribution to the SaudiMEDs areas of expertise may provide students and faculty with a picture of the overall organization of the curriculum and help them to prepare for their teaching, learning, and assessment activities[19,25]. The map may also set the stage for legitimate curricular management decisions to reorganize the distribution of subjects and skills across the modules and redefine the assessment strategies more appropriately. We have identified several clinical presentations and essential skills that our curriculum is deficient in, in relation to the SaudiMEDs, and therefore need to be addressed. However, and understandably, most of the uncovered essential skills are hospital-based and hence would more likely be taught and mastered in the internship period. This emphasizes the importance of setting a structured program for the internship period as part of the undergraduate training, which is already proposed in the third phase of the SaudiMEDs project. Also, some redundancies have emerged and may require attention in the future plans for curriculum development. For example, dermatology and otolaryngology topics appeared to be dealt with in a relatively large number of modules, and if necessary, revision of these subjects may result in some additional space to bridge the gap with regard to the deficiencies. The ability to delineate such gaps and redundancies in the curriculum is one of the prime advantages of curriculum maps, as indicated in the literature[6,19,22,26-28].

Furthermore, the map provides insights into the degree of integration in our program, which is another one of its advantages because the curriculum involves a horizontal and vertical integration approach, particularly in the preclinical phase. Thus, at a glance, the map demonstrates the level and the modules that contribute to each subject or skill area. Thereafter, decisions regarding the appropriateness of the stage and the courses in which each subject or skill is taught could be effected. While this exercise may provide a model to the growing community of medical schools in Saudi Arabia wishingto cross-reference their curricula against the SaudiMEDs framework, it may also demonstrate to the wider community of medical educators that curriculum mapping remains an essential tool for curriculum development.

Our experimentation with curriculum mapping has yielded a unique barcode-like shape that depicts the relationship between the formal curriculum at our college and the SaudiMEDs framework. The barcode exhibits the alignmentof our taught modules in relation to the main knowledge and skill domains of the national framework. This approach has sparked in our minds the notion of curriculum barcoding. Thinking loudly, we asked ourselves,is it possible to barcode the curriculum in view of a national standard? Would it be a legitimate mechanism to define the curriculum in relation to the minimum training requirements stipulated by the SaudiMEDs? Would it help the wider community of medical schools in the kingdom to define their curricula in view of the national specifications and requirements? Obviously, it might be too early to answer those questions. However, the idea might be appealing given the increased aptitude for standardization and homogenization of medical education and training in the present era of globalization[30]. In addition, the notion of barcoding might be conducive to the growing enthusiasm for the adoption of national and international competency frameworks currently noted in different jurisdictions. It might be possible to translate the basic medical program into a barcode in terms of where the essential matrix of knowledge, skills, and competenciesdescribed by the SaudiMEDs are addressed in the curriculum. Once that is done, the SaudiMEDs barcode might be used to codify and test the alignment of the basic medical curriculum to the requirements of the national framework similarto how barcode machines in the market translate an aggregation of columns into the price. The such process might also be endeared in a world dominated by computerization and digital technologies. Of course, the SaudiMEDs are not intended as a formal curriculum;it preserves the autonomy of medical schools to meet the requirements of their local communities. As such, standardization of basic medical programs is not required to allow for barcoding their curricula to the SaudiMEDs. Instead, the process is more likely codifying the curriculum against the minimum requirements set by the national standard, and can therefore be done regardless of the curriculum design and structure.

Once created, the unique shape of the SaudiMEDs barcode of a given basic medical curriculum in the kingdom might serve as a novel method to display its identity in view of the SaudiMEDs and to demonstrate the congruence between that curriculum and the national standard. Besides, we believe that the barcode might constitute a platform or common language to facilitate communication of curriculum content and characteristics in relation to achievement of the national requirements among the community of medical education in Saudi Arabia. We believe that the SaudiMEDs barcode of a given college might help the responsible authorities to figure out the degree of alignment between the college's curriculum and the national specification requirements. As such, the process might also have implications to the overseeing and accreditation projects of basic medical programs in the country. The above-mentioned advantages might be few examples of others if the SaudiMEDs barcode turned to be applicable. However, and understandably, this quantitative approach alone might not be enough for curriculum assessment and qualitative and other evaluative methods in this concern might be essential. We are aware that this novel idea is still in its infancy and therefore requires further elaboration and testing to endorse its applicability and usefulness in our setting and perhaps other medical schools in the kingdom. This should be the subject of future studies. Lastly, we call for initiation of immense discussion among the community of medical schools in the kingdom to explore the utility and the pros and cons of the SaudiMEDs barcode as a promising method of curriculum description and evaluation with regard to the set of national requirements.

Curriculum mapping is a powerful tool for curriculum development and improvement. The curriculum in our medical college is comparable to and includes most of the skills and knowledge domains of the SaudiMEDs competency framework; however, some gaps need to be addressed. The curriculum map provided a tool for the recognition of unnecessary overlaps in the program and an insight into the appropriateness of the integrated teaching approaches employed in the college. We hypothesized a novel method to test the alignment of our curriculum, and perhaps other corresponding programs in the kingdom, to the SaudiMEDs framework. We described the former as the SaudiMEDs barcode, which we hope to have implications to fulfillment of all the desired competenciesby the future Saudi doctors and to promote overseeing and accreditation of basic medical programs in the kingdom. Data generated from this exercise are useful for informing the decisions and actions that might be taken to improve the curriculum. In addition, it emphasizes the need for a structured training system in the internship period as part of the undergraduate medical program. Further studies in this field are recommended in our college to help in providing continuous assessment and optimization of our curriculum. At the national level, we recommend further studies on curriculum mapping with established guidelines to promote transparency, accessibility to, and improvement of basic medical curricula in the kingdom. Besides, we anticipate further work to test the utility of the SaudiMEDs barcodeas a promising tool to ensure comparability and alignment of the basic medical programs in Saudi Arabia to the national training standards.

Continued here:
Curriculum Mapping for Curriculum Development: The Notion of Curriculum Barcoding in View of the Saudi Medical Education Directives Framework...

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Adults with HIV have a greater risk for developing type 2 diabetes (T2D) compared with someone never diagnosed with HIV, Amanda Willig, PhD, notes. However, medications used to treat diabetes dont always control blood sugar as well for someone with HIV. Identifying factors associated with diabetes risk that are similar to the general population, as well as those that are unique to HIV, can help clinicians provide the best preventive care for patients.

For a study published in AIDS, Dr. Willig and colleagues sought to examine the incidence of T2D among people with HIV and related risk factors. They conducted a retrospective cohort study at an academic HIV clinic in the Southeastern United States, obtaining EMR data on demographics and clinical characteristics.

We studied over 4,000 eligible patients with available EMR data who received care at our HIV treatment clinic, she explains. To understand the role that various risk factors play in the current treatment era, we limited our investigation to a 10-year period from 2008-2018.

The researchers defined diabetes using three categories: A1C values equal to or greater than 6.5% and/or two glucose results greater than 200 mg/dL at least 30 days apart; a diabetes diagnosis in the EMR; or exposure to diabetes medication.

Patient Characteristics & HIV-Associated Factors Influence Diabetes Risk

We were surprised to see such a rapid increase in diabetes incidence and prevalence in just 10 years (Figure), Dr. Willig says. The continued increasing trajectory of diabetes burden in people with HIV highlights the critical need for access to diabetes prevention care in this population.

The researchers identified 252 incident cases of diabetes among 4,113 people with HIV. Diabetes incidence increased from 1.04 per 1,000 person-years in 2008 to 1.55 per 1,000 person-years in 2018. Factors related to incident diabetes included BMI (HR, 10.5), liver disease (HR, 1.9), steroid exposure (HR, 1.5), and use of integrase inhibitors (HR, 1.5). Other related factors included lower CD4+ cell counts, duration of HIV infection, exposure to non-statin lipid-lowering therapy, and dyslipidemia.

The strong association of both low and high body weights with diabetes risk indicate that weight management programs for people with HIV can play a crucial role in diabetes prevention, she says. Integrase inhibitors may also impact body weight, and the potential association of this medication class with diabetes incidence highlights the need for preventive lifestyle counseling to minimize the potential impact of these medications, along with consideration of appropriate ART regimens in populations at highest risk for diabetes. Caution in prescribing and utilizing steroids in people with HIV is warranted, with close monitoring for potential side effects.

Modifiable Risk Factors, Social Determinants of Health, & COVID-19

As patients with HIV live longer, clinicians and researchers need to focus care not just on improving longevity but on maintaining good QOL, Dr. Willig notes.

Modifiable risk factors, such as body weight, certainly play a role in diabetes risk, and greater emphasis on lifestyle modification for diabetes prevention is needed to slow the trajectory of increasing diabetes prevalence, she says. However, the impact of HIV infection and certain ART regimens on diabetes risk indicates that these programs should be tailored to address the unique risk factors of those with HIV, including identifying food-insecure patients who may need assistance in meeting nutritional needs and providing medical nutrition therapy.

Dr. Willig pointed to multiple areas for future research highlighted by the current study.

Other research teams have shown that pharmaceutical treatment for diabetes control may take longer to have equivalent impact for someone with HIV, she notes. However, we do not know if lifestyle interventions such as nutrition and exercise also need to be provided for longer intervals or precisely how nutrition and exercise should be tailored for this population. A greater understanding of social determinants of health that are associated with the risk factors identified here is key to effectively tailoring diabetes prevention efforts.

Additionally, investigators need to determine which medical and behavioral treatments are most effective to offer in tandem with integrase inhibitor use to minimize undesirable metabolic effects, Dr. Willig continues.

A separate but related issue is the COVID-19 pandemic. We need to explore whether COVID-19 infection or the associated stressors of life during a pandemic have impacted diabetes incidence, and, if that is shown to be the case, whether that changes medical management for diabetes in people with HIV, she says.

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Prevention Strategies 'Critical' as Diabetes Rates Rise in Patients With HIV - Physician's Weekly

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LEARN HOW YOUR PLANNED GIFT CAN HELP THE AMERICAN LEGION

After taking a fall last month, my doctor suggested I start doing balance exercises. Do you have any tips for balance?

Most people do not think about practicing their balance, but it is a good idea to start doing so. In the same way that you walk to strengthen your heart, lungs and overall health, you should practice maintaining your balance.

As we age, our ability to maintain balance declines, which can increase your risk of falling. More than one in three individuals 65 or older falls each year, and the risk only increases with age. A simple fall can cause a serious fracture of the hip, pelvis, spine, arm, hand or ankle, which can lead to hospitalization, disability, loss of independence and potential fatalities.

How Balance Works

Balance is the physical ability to distribute your weight in a way that enables you to hold a steady position or move at will without falling. Balance is controlled by a complex combination of muscle strength, visual inputs, inner ear workings and specialized receptors in the nerves of your joints, muscles, ligaments and tendons, which help with orientation. These factors are sorted out in the sensory cortex of your brain, which takes this information and gives you balance. Over time, these neurological pathways dull and causes individuals to gradually lose their balance.

Poor balance can lead to a vicious cycle of inactivity. Individuals who feel unsteady end up curtailing certain activities, which can lead to inactivity. If they are continuously inactive, they no longer challenge their balance systems or their muscles. As a result, both balance and strength decline and simple acts like strolling through a grocery store or getting up from a chair become trickier for these individuals. This can shake their confidence and cause them to become even less active.

Balance Exercises

If you have a balance problem that is not tied to illness, medication or some other cause, simple exercises may help preserve and improve your balance. Some basic exercises you can do include:

One-legged stands: Stand on one foot for 30 seconds or longer, then switch to the other foot. You can do this while brushing your teeth or even while waiting in line somewhere. In the beginning, you might want to have a wall or chair to hold on to in case you lose your balance. Heel rises: While standing, rise up on your toes, lifting your heel as high as you can. Drop back to the starting position and repeat the process 10 to 20 times. You can make this more difficult by holding light hand weights. Heel-toe walk: Take 20 steps and with every step, touch your heel to your toe on your opposite foot. Keep your focus straight ahead instead of looking down at your feet. Sit-to-stand: Without using your hands, get up from a straight-backed chair and sit back down 10 to 20 times. This improves balance and leg strength.

Additional balance exercises are part of a resource created by the National Institute on Aging that offers free booklets that provide illustrated examples of many appropriate exercises. You can order your free copy online or by calling 1-800-222-2225.

Savvy Living is written by Jim Miller, a regular contributor to NBCs Today Show. The column, and others like it, is available to read via The American Legions Planned Giving program, a way of establishing your legacy of support for the organization while providing for your current financial needs.

Link:
How to improve your balance | The American Legion - The American Legion

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JOINT BASE LEWIS-MCCHORD, Wash. This month, the Cold Steel Brigade conducted its third Command Post Exercise with California National Guards 40th Infantry Division partners to prepare the division for operational readiness at the Battle Simulation Center at Marine Corps Base Camp Pendleton, California.

What I love about these exercises is we get to train ourselves as OC/Ts, said U.S. Army Maj. Gen. Mark Landes, the First Army Division East commander and exercise director. Anytime we get feedback from a unit like the 40th Infantry Division, which is reacting so quickly, its a lot of fun.

The Sunburst Division Soldiers progress since their first CPX earlier this year was evident to the observer, coach, trainers of the 189th Infantry Brigade.

The 40th Infantry Division has significantly improved in conducting rear command post operations, said Lt. Col. Amanda Stambach, the lead sustainment OC/T for CPX III and commander of 1-357th Brigade Support Battalion, 189th Infantry Brigade. With each exercise, the team has made gains in refining their battle rhythm, assigning roles and responsibilities within command posts, and tailoring working groups to fit their needs.

The training program was designed to have participants work as a team during realistic training scenarios.

This training path has put this diverse group of National Guardsmen and women through a vigorous regimen focused on simulating a first combat experience, said Maj. Lance Brender, a movement and maneuver deputy and executive officer of 2-357th Infantry Battalion, 189th Infantry Brigade. Shared understanding is knowing your own business, then telling everyone else who needs to know, too. It sounds simple, but the execution of it in combat is nuanced and difficult. It means distilling a great deal of raw data into pertinent information and, ultimately, a wise decision.

Each warfighting function team had a distinct role in contributing to the success of the exercise.

The 40th Infantry Division sustainment team was focused on building a common operating picture and integrating with the division plans cell in order to better anticipate sustainment requirements in support of future operations, said Stambach. The Forge team [Soldiers of 1-357th Brigade Support Battalion] conducted analysis to determine the best OC/T support package for the exercise, ensuring we had the right balance of experienced personnel to cover logistics, personnel and medical functions, but not have an overwhelming presence in 40th Infantry Divisions command posts.

The Cold Steel Brigade prides itself on being a learning community, providing OC/Ts who are experts in doctrine with interpersonal skills.

The partnership between the active-duty federal force, in our case the 189th Infantry Brigade, and the state Guards is a vital bond of camaraderie trust, Brender said. We approach our training days with the 40th Infantry Division as precious opportunities to make them the most ready, most lethal force they possibly can be as they contribute to the security of the free world.

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'Cold Steel' Builds on Partnership with 40th Infantry Division - National Guard Bureau

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Club Members Offered Complimentary Headspace Subscription to Encourage Mental Health And A More Holistic Approach To Wellness

CARLSBAD, Calif., Oct. 3, 2022 /PRNewswire/ -- Fitness industry leader 24 Hour Fitness has teamed up with Headspace Health, the provider of the world's most accessible and comprehensive digital mental health platform,in a partnership to offer complimentary three-month Headspace subscriptions to new and existing 24 Hour Fitness club members on a first come first serve basis, while supplies last. Headspace offers a range of tools to help people stress less, sleep better, get moving, and to find more focus and joy. The partnership launches its complimentary offer on Monday, October 10, World Mental Health Day, and is an important part of 24 Hour Fitness's holistic strategy to offer dynamic fitness and wellness experiences to club members. For more information, visithttps://www.24hourfitness.com/headspace.

"Our partnership provides support of full mind and body health for our members," said Karl Sanft, CEO, 24 Hour Fitness.

"I've always been proud of our company's mission to create a healthier, happier world," said Karl Sanft, President and CEO, 24 Hour Fitness. "Now more than ever, this mission extends beyond physical fitness to include the importance of mental health and well-being. That's why our partnership with Headspace Health is so timely. The science-based mindfulness and meditation app will offer a new level of wellbeing to both our team members and club members -- because we want everyone to develop a healthy mind and bodythe best combination to tackle whatever your day brings."

Why Headspace?

It's all about the synergy between the two brands. 24 Hour Fitness has listened to its club members and what they want from their fitness experience including a fitness space that supports both mind and body health and is a refuge to help reset their next 24 hours. 64% of the 24 Hour Fitness audience rate emotional well-being as more important now compared to 51% pre-pandemic. Additionally, members highly regard the importance of being active for life and work out to feel good (more so than losing weight), while leveraging mobile apps to keep track of their fitness habits both inside and outside of the club environment.

Headspace offers more than 1,000 hours of premium mindfulness content from guided meditations, eyes-open exercises like mindful walks and runs, breathing and wind-down exercises, focus music, sleep content and more to help people live happier lives. Headspace is a leading player in the meditation and mindfulness category that is committed to advancing the field of mindfulness and meditation through clinically-validated research. In fact, research shows that 30 days of Headspace resulted in 32% decrease in stress, and 4 weeks of Headspace improved focus by 14%-- making Headspace the perfect complement to a 24 Hour Fitness membership.

"Decades of research show that physical and mental health are deeply intertwined," said Katie DiPerna, Senior Vice President, Partnerships, Headspace Health. "With this partnership, we're thrilled to bring awareness of the power of meditation and mindfulness to the 24 Hour Fitness community, and to provide their members and employees with a new tool to improve their overall health and wellbeing."

24 Hour Fitness / Headspace Complimentary Subscriptions The Details

With the goal of helping club members develop a holistic wellness plan inside as well as outside the club 24 Hour Fitness offers complimentary Headspace subscriptions to club members (with a similar offer extended to the company's team members). Participants will receive a three-month complimentary subscription to the Headspace app and can choose short meditations to stay on track throughout the day, or longer sessions to deepen their practice. Most recently, Headspace has revealed new content collections that celebrate and empower women, provide education on stress management, and support parents and students of all ages during the back to school season. Also included are tools to help members get a good night's restsleep meditations, sleep music, wind downs and specially-designed sleepcasts.

24 Hour Fitness has built a series of partnerships that offer club members and guests a variety of fitness and wellness experiences that can help support overall health. Recently launched popular partnership programs include Nutrishop and recovery program iCRYO. The company has also entered the boutique fitness space with a new HIIT offering P.A.S.E. Factor, among other partnerships.

About 24 Hour Fitness

Celebrating nearly 40 years as an industry leader, 24 Hour Fitness helps change lives every day through fitness. Operating a network of approximately 300 clubs in 11 states, the company offers clean and spacious clubs furnished with a variety of strength, cardio and functional training equipment in a comfortable environment that conveys the feeling of community and inclusivity for more than 2 million club members. Membership options offer club amenities including functional training equipment, GX24 group exercise studio and cycle classes where members can reserve a spot for their favorite instructor-led live class within a club community that supports and inspires every member to lead a healthier, happier life.Friendly and knowledgeable fitness professionals also stand ready to deliver dynamic personal and group training programs.The company's 24GO app provides touch-free club check-in as well as a variety of on-demand workouts to support fitness at home, in the club or on the go. This diverse combination of fitness options is designed to engage and motivate every 24 Hour Fitness member to explore and enjoy a lifelong relationship with mind and body health and wellness. For further information and to find a club near you, visit http://www.24hourfitness.com.

About Headspace

Headspace was created with one mission in mind: to improve the health and happiness of the world. As one of the first meditation apps on the market, Headspace remains a leader in mindfulness and mental training. For more information, please visit us at http://www.headspace.com, or follow us on Facebook, Twitter, Instagram and TikTok.

Headspace Health is a leading provider of mental health and wellbeing solutions, touching the lives of over 100 million people in 190 countries. Through our flagship Headspace brand, we provide mindfulness tools for everyday life, including meditations, sleepcasts, mindful movement, and focus exercises. Our enterprise brands, Headspace for Work and Ginger, are distributed through over 3,700 enterprises, including Starbucks, Adobe, Delta Air Lines, and ViacomCBS; and through health plans such as Cigna. Our members and enterprise partners' employees have access to mindfulness and meditation tools, CBT, coaching, therapy, and psychiatry, ultimately helping them to be healthier and more productive. To learn more about Headspace Health and our family of brands, visit http://www.headspacehealth.com.

SOURCE 24 Hour Fitness

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24 Hour Fitness and Headspace Health Launch Partnership on World Mental Health Day - PR Newswire

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Fiture has announced the release of the new Fiture Mini, which as the name suggests, is a smaller and more affordable version of its smart mirror. Included with this announcement is that both the original mirror (now named Core) and Mini will be available on Amazon starting this month.

We reviewed the Fiture Core earlier this year and found it to be a strong contender to the Mirror by Lululemon. While similar in some ways, what makes Fiture more unique is rep tracking and form feedback that is provided via what they call their Motion Engine.

Maggie Lu, CEO of Fiture, wrote:

Fiture is leading the charge on making fitness more fun. Many people have started a fitnessjourney in the past couple of years but found it hard to sustain. We think fitness should be funand natural-focus more on how it makes you feel rather than numbers and calories

At Fiture, we believe that the magic happens when the hardwareand content come together to deliver the experience. With the launch of Mini, we hope to bringthis experience to more families.

While Fiture is not available on Amazon just yet, it should be soon. In the meantime, you can learn more about the Fiture Core and Fiture Mini on their website here.

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Fiture announces more affordable Mini smart fitness mirror - Connect the Watts

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, Fla. Planet Fitness is opening more than 80 locations in Florida and Georgia for anyone impacted by Hurricane Ian to use their locations free of charge.

The franchise is letting those affected by the storm use its shower facilities, fitness equipment, massage chairs, electrical outlets and more.

>>> STREAM CHANNEL 9 EYEWITNESS NEWS LIVE <<<

According to a news release, Planet Fitness is committed to helping the communities it serves, including offering showers and gym benefits to those displaced in areas of Florida and Georgia from hurricane Ian.

Planet Fitness does not offer towel service or shampoo, and guests must be older than 13 years old to use fitness equipment.

Read: Central Florida counties provide updates for trash collection after Hurricane Ian

The gym locations will be free until Oct. 9, the company said.

Read: Orlando city officials ask residents to limit water usage following sewer issues

Here is the list of locations in Central Florida:

Osceola County

St. Cloud - 4020 13th St

Flagler County

Palm Coast (Hwy 100) - 5615 State Hwy 100 E Unit 100

Palm Coast (Old Kings Commons) - 7 Old Kings Rd N, Units 20-32

Marion County

Ocala - 3233 SE Maricamp Rd, Unit 500

Ocala (SW) - 2800 SW 24th Ave

Polk County

Lakeland (North) - 6208 US Hwy 98

Lakeland (South) - 4315 S Florida Ave

Volusia County

Daytona Beach - 1423 S Nova Rd

Deland - 111 E International Speedway Blvd

Orange City - 860 Saxon Blvd

Lake County

Clermont - 2620 US Hwy 27 South

Eustis -2830 S Bay St

Leesburg - 735 N 14th St

Brevard County

Cocoa - 6221 N Hwy 1

Melbourne - 840 N Apollo Blvd

Rockledge - 1802 US Hwy 1

Satellite Beach - 1024 Highway A1A

Palm Bay - 160 Malabar Rd

Seminole County

Altamonte Springs - 280 S State Rd 434

Lake Mary - 3005 W Lake Mary Blvd

Winter Springs - 300 E Florida 434

Casselberry -204 Sausalito Blvd

Oviedo - 19 Alafaya Woods Blvd

Orange County

Apopka - 1569 W Orange Blossom Trail

Kissimmee - 3107 W Vine St

Orlando (Metro West) - 5920 Metropolis Way

Orlando (Dr Phillips) - 8956 Turkey Lake Rd, Ste 1000

Orlando (Holden) - 4526 S Orange Blossom Trail

Orlando (Metro West) - 5920 Metropolis Way

Orlando (Fashion Square) - 3203 E Colonial Dr

Read: Heres when Central Florida schools expect to reopen after Hurricane Ian

Click here to download the free WFTV news and weather apps, click here to download the WFTV Now app for your smart TV and click here to stream Channel 9 Eyewitness News live.

2022 Cox Media Group

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Planet Fitness is opening its doors to those impacted by Hurricane Ian - WFTV Orlando

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Durga Ashtami is one of the most auspicious day during the Navratri festival and Durga Puja festivities. Maha Ashtami is commemorated with much zeal across the country. Maa Durga is known for her infinite feminine valour and resilience. This day celebrates the victory of Goddess Shakti over the demon Mahishasura. Given how Maa Durga is the perfect epitome of inner strength, On this occasion, Bollywood celebrity Malaika Arora reminded her fans of the inner warrior within each one of them.

Dropping her Monday Motivation post on Instagram, she is seen performing the warrior 3 pose. She also urged everyone to keep their fitness game on point.

Yoga is known to bring us closer to our consciousness and helps to keep us calm and centered. According to Malaika Arora, while performing the warrior 3 pose, we might feel certain intense feelings descending upon us. But we must gather all our courage to stay focused and learn our ways to let go of those unwanted emotions.

The Instagram caption of the video by Malaika Arora reads, This week were focusing on finding our center. Finding that inner balance that keeps us still, calm, and stable. If youre doing the warrior 3 poses with me, some intense feelings might rise up that youd be wanting to let go of. You may also feel challenged, but its nothing you cannot handle. Always remember the amazing warrior that you are!

Warrior 3 pose is a standing posture that has its focuses on learning to make you stand balanced, whilst strengthening your legs, ankles, and core. Alongside, it also gives strength to your shoulders and back muscles.

Step 1: start in the Warrior Pose 1 putting forth your right foot forward.Step 2: Kneel down firmly with your right heel to raise your lower belly, bringing the abdominals in and up and releasing your tailbone down.Step 3: Hold your right outer hip into your midline as make your leg straight.Step 4: Push your arms to energize them and add more length to your side body.Step 5: Move your left inner thigh towards the ceiling to turn your left outer hip forward, and move in axis onto your back toes so that your back leg ends up in a neutral position.Step 6: Stretch your spine by inhaling,Step 7: Exhale while moving your torso forward and lengthen your arms out ahead.Step 8: Transfer all your weight onto your front foot and bend forwards so that your left leg stands parallel to the floor.Step 9: Make sure that your upper arms cover your ears, and your head, torso, pelvis, and lifted left leg all form a straight line.Step 10: Continue turning your left inner thigh towards the ceiling so that your leg remains neutral and your pelvis is leveled.Step 11: Use the strength of your right outer hip to provide stability for your standing leg.Step 12: Push your left heel backward while extending towards the front with your arms, the crown of your head, and your sternum.Step 13: Make your lower belly move towards your left heel while providing support for your lower back.Step 14: Hold this posture for 5-10 breaths, kneel down with your right knee carefully, and step back with your left foot returning to warrior pose 1.Step 15: Get back to normal, and repeat the same process on the other side.

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On Ashtami, fitness queen Malaika Arora reminds us to keep the warrior within us alive - Health shots

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NEW YORK, Oct. 03, 2022 (GLOBE NEWSWIRE) -- Questexs Sibec Europe|UK, Europes leading one-to-one event for the fitness industry, concluded its event last week at the Anantara VilamouraAlgarve Resort, in Portugal, with over 750 one-to-one meetings between premier global suppliers and owners and operators of health and fitness facilities in Europe and the UK.

For over 20 years, it continues to be Europes leading one-to-one event and combines the unique, personalized, intimate concept with organized networking activities and events, lavish receptions, and exceptional education, this year led by unparalleled industry voices: Andreas Paulsen, CEO, Europe Active, and David Stalker, President, Europe Active and CEO, Myzone and Dr. Paul Bedford, Owner, Retention Guru.

With the expansion of the hosted buyer base into the Middle Eastern region, Sibec Europe|UK will be renamed Sibec EMEA. The event will take place 26-29 September at the Hilton Sorrento Palace in Sorrento, Italy.

While recruiting for this years event, we received incredible interest from all over the globe and we had to unfortunately turn people away due to space limitations and the Europe-focused strategy, said Marty McCallen, Managing Director, Questex Fitness Group, organizer of Sibec Europe|UK. At the request of our audience of suppliers, we will expand the event to a larger geographic region and give the entire audience the most valuable event for their business needs. We are excited to host the event next year at the beautiful Hilton Sorrento Palace.

For more information on Sibec EMEA, click here.

About SibecOrganized by Questex, Sibec events are the longest running one-to-one events for professionals in the fitness industry and reach a wide crosssection of participants from fitness and wellness products, manufacturers and distributors to club owners, directors, and managers. With a minimum of 15 one-to-one appointments, multiple networking opportunities, and education, Sibec events, presented by Club Industry, provides the perfect meeting ground for the worlds most eliteand qualified buyers of fitness equipment and supply looking to meet the top global companies.

About QuestexQuestex helps people live better and longer. Questexbrings people together in the markets that help peoplelive better:travel, hospitality,andwellness; the industries that help peoplelive longer:life scienceandhealthcare;and thetechnologiesthat enable and fuel thesenew experiences. We live intheexperience economyconnectingourecosystem throughlive events, surrounded by data insights and digital communities. We deliver experience and real results.It happens here.

Media ContactJennifer RosenGroup Marketing DirectorQuestex Wellness GroupJrosen@questex.com

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Questex's Sibec to Bring the Fitness Industry Together in - GlobeNewswire

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